Percutaneous Cardiopulmonary Support Research Articles

In-Hospital Death and End-of-Life Status Among Patients With Adult Congenital Heart Disease - A Retrospective Study Using the JROAD-DPC Database in Japan.

The end-of-life (EOL) status, including age at death and treatment details, of patients with adult congenital heart disease (ACHD) remains unclear. This study investigated the EOL status of patients with ACHD using a nationwide Japanese database.Methods and Results: Data on the last hospitalization of 26,438 patients with ACHD aged ≥15 years, admitted between 2013 and 2017, were included. Disease complexity (simple, moderate, or great) was classified using International Classification of Diseases, 10th Revision codes. Of the 853 deaths, 831 patients with classifiable disease complexity were evaluated for EOL status. The median age at death of patients in the simple, moderate, and great disease complexity groups was 77.0, 66.5, and 39.0 years , respectively. The treatments administered before death to patients in the simple, moderate, and great complexity groups included cardiopulmonary resuscitation (30.1%, 35.7%, and 41.9%, respectively), percutaneous cardiopulmonary support (7.2%, 16.5%, and 16.3%, respectively), and mechanical ventilation (58.7%, 72.2%, and 75.6%, respectively). Overall, 70% of patients died outside of specialized facilities, with >25% dying after ≥31 days of hospitalization. Nationwide data showed that patients with ACHD with greater disease complexity died at a younger age and underwent more invasive treatments before death, with many dying after ≥1 month of hospitalization. Discussing EOL options with patients at the appropriate time is important, particularly for patients with greater disease complexity.

Successful surgical management of ventricular septal perforation following left ventricular free wall rupture due to acute myocardial infarction: a case report

BackgroundThe mechanical complications associated with acute myocardial infarction can be fatal. We report a life-saving case of a very elderly patient with consecutive mechanical complications of acute myocardial infarction.Case presentationA 90-year-old woman was transferred to our hospital for emergency care due to chest pain. She underwent emergency percutaneous coronary intervention of the left anterior descending branch and was diagnosed with acute myocardial infarction and intra-aortic balloon pumping insertion was performed. After returning to the intensive care unit, she experienced chest pain and went into shock. Echocardiography showed left ventricular free wall rupture, and percutaneous cardiopulmonary support was established. Emergency left ventriculoplasty was performed for the left ventricular free wall rupture. A ventricular septal perforation was observed on postoperative day 9, and its closure through right ventriculotomy was performed on postoperative day 10. On the 128th postoperative day, the patient was transferred to the hospital for rehabilitation.ConclusionsA 90-year-old patient with consecutive left ventricular free wall rupture and ventricular septal perforation after acute myocardial infarction was successfully managed with two surgeries.

General anesthesia with remimazolam for emergency cesarean section in a patient with acute infective endocarditis: a case report

BackgroundThe anesthetic management of pregnant women with acute heart failure remains challenging with regard to maintaining the hemodynamic status of the mother and baby. The likelihood of decreased blood pressure is lower with remimazolam than with propofol. However, there is no report of general anesthesia with remimazolam for cesarean section.Case presentationThe patient was a 34-year-old pregnant woman who was diagnosed with acute heart failure associated with infective endocarditis. We performed cesarean section under general anesthesia using remimazolam, with percutaneous cardiopulmonary support on standby. The mother’s mean blood pressure was maintained above 65 mmHg during the surgery, without catecholamines or vasopressors. The infant’s Apgar scores were 4 at 1 min and 7 at 5 min.ConclusionCesarean section was successfully performed under general anesthesia with remimazolam in a pregnant patient with acute heart failure. Further studies are needed to clarify the association between remimazolam and neonatal hypotension.

Predictors of In-Hospital Death in Patients With Acute Myocardial Infarction.

Factors such as age, vital signs, renal function, Killip class, cardiac arrest, elevated cardiac biomarker levels, and ST deviation predict survival in patients with acute myocardial infarction (AMI). However, the existing risk assessment tools lack comprehensive consideration of catheter-related factors, and short-term prognostic predictors are unknown. This study aimed to clarify in-hospital prognostic predictors in hospitalized patients with AMI. Five hundred and thirty-six patients who underwent percutaneous coronary intervention (PCI) for AMI were divided into non-survivor (n = 36) and survivor (n = 500) groups. Coronary risk factors, laboratory findings, angiographic findings, and clinical courses were compared between the two groups. Multiple logistic regression was used to analyze in-hospital death in pre- and post-PCI phases. In the pre-PCI phase, multiple logistic regression analysis revealed several predictors of in-hospital death, including systolic blood pressure [odds ratio (OR) = 0.985, p = 0.023)], Killip class ≥2 (OR = 14.051, p <0.001), and chronic kidney disease (OR = 4.859, p = 0.040). In the post-PCI phase, multiple logistic regression analysis revealed additional predictors of in-hospital death, including Killip class ≥2 (OR = 5.982, p = 0.039), presence of lesions in the left main trunk (OR = 51.381, p = 0.044), utilization of intra-aortic balloon pumps and percutaneous cardiopulmonary support (OR = 6.141, p = 0.016), and presence of multi-vessel disease (OR = 6.323, p = 0.022). Predictors of in-hospital death in AMI extend beyond conventional risk factors to include culprit lesions, mechanical support, and multi-vessel disease that manifest post-PCI.

Papillary fibroelastoma of the aortic valve: occlusion of the left main coronary artery.

A 53-year-old woman with palpitations and respiratory distress as her main symptoms, which had resulted in a cardiac arrest, was referred to the emergency room. Coronary angiography (CAG) with percutaneous cardiopulmonary support (PCPS) was performed, but no severe stenosis was found. The patient was diagnosed with vasospastic angina, treated medically, and discharged to her home. Six months later, however, during hospitalization for sick sinus syndrome, she suddenly developed runs of ventricular tachycardia. Therefore, CAG with PCPS was again carried out and revealed an occlusion of the left main trunk (LMT) of the coronary artery (Panel A, arrow). Intravascular ultrasound imaging was also performed (Panel B), and a plausible thrombus formation associated with coronary spasm was diagnosed. An emergency surgical intervention was therefore carried out. Intraoperative transoesophageal echocardiography imaging showed both a large mass at the aortic valve that may have occluded the LMT (Panel C, Supplementary data online, Video S1), and a previously undiagnosed severe aortic valve regurgitation caused by the mass. Aortic cross-clamping and a cardiac arrest were conducted; a huge mass originating from the right coronary cusp (RCC) of the valve was found (Panels D and E, arrowheads) and resected. No thrombus formation in the coronary artery was observed. Post-operatively, the patient's angina resolved without any sign of aortic regurgitation. The pathology report revealed a papillary fibroelastoma (PFE). This series of symptoms was caused by embolization within the coronary artery and the presence of a huge PFE, which together caused this rare condition.

難治性院外心原性心停止に対する初期心電図によるpercutaneous cardiopulmonary support導入時間の検討(Analysis of the percutaneous cardiopulmonary support implementation time for refractory out–of–hospital cardiogenic cardiac arrest by initial electrocardiogram)

要旨【目的】治療抵抗性心停止に対する経皮的心肺補助（以下，PCPS）の転帰良好な因子として，初期心電図がショック適応心リズム（以下，ショックリズム）と心停止（以下，CA）からPCPS開始までの時間（以下，CA to PCPS）が短いことが挙げられる。しかし，近年ではショック非適応心リズム（以下，非ショックリズム）でも転帰良好な症例が報告されており，院外心原性心停止における初期心電図別のCA to PCPSと1か月後の転帰良好について検討した。【対象】これは単施設，後方視的研究であり，2000年1月から2017年3月に院外心原性心停止症例に対してPCPSを導入した219例（平均58歳，男性193例）を対象とした。【結果】ショックリズム群（167例）と非ショックリズム群（52例）において，転帰良好率は31% vs 10%（p＝0.003）であり，CA to PCPSの中央値は44.0分 vs 35.0分（p＝0.014）であった。さらにCA to PCPSを5分ごとに区切り転帰良好率を検討すると，ショックリズム群では36～40分で59%であったが，41～45分では33%まで低下しており，非ショックリズム群では40分以降に転帰良好は存在しなかった。【結語】心停止から40分以内のPCPS導入がより転帰良好になると考えられたが，非ショックリズム群ではさらに短縮する必要がある。

ECPR後に判明した右総腸骨動脈瘤破裂に合併した腸間膜損傷と腹部コンパートメント症候群に対して集学的治療で救命しえた1例(Successful treatment of mesenteric injury and abdominal compartment syndrome with a ruptured right common iliac artery aneurysm after extracorporeal cardio pulmonary resuscitation using intensive care: a case report)

要旨 48歳の男性。突然の上腹部痛を主訴に救急要請，搬送中に心肺停止となった。急性心筋梗塞による心肺停止を疑い，venoarterial extracorporeal membrane oxygenation（VA–ECMO）を導入し心拍再開した。CT検査にて右総腸骨動脈瘤破裂と診断し，VA–ECMO下でendovascular aortic repair （EVAR）を施行した。動脈瘤の止血は得られたが，腹部膨満を認め低血圧が遷延した。腹部コンパートメント症候群と診断，緊急開腹手術を施行し，活動性出血を伴わない小腸間膜裂創を認め，動脈瘤および小腸間膜裂創を挟むようにパッキングガーゼを留置，open abdominal management（OAM）を施行した。しかし，術後に循環動態が不安定なため再手術を施行すると，小腸間膜裂創より動脈性出血を認め，結紮止血し再度OAMとした。第2病日にVA–ECMOから離脱，第4病日に閉腹術を施行し，第41病日に独歩退院した。Extracorporeal cardio pulmonary resuscitation後に判明した動脈瘤破裂に対して，EVARで動脈瘤の止血が得られても，破裂瘤に起因する血腫による出血性臓器損傷などにより腹部コンパートメント症候群を来す可能性があるため，超音波検査を繰り返すなど，腹腔内出血に留意し診療を継続する必要がある。

Central extracorporeal membrane oxygenation with left-ventricular vent for fulminant myocarditis: a retrospective study.

Fulminant myocarditis presents as acute severe heart failure and requires mechanical cardiocirculatory support. Left-ventricular (LV) decompression is necessary for the successful recovery of these patients. This retrospective study aimed to evaluate the functional outcomes of providing central extracorporeal membrane oxygenation (ECMO) with LV decompression for the treatment of refractory fulminant myocarditis. Between January 2015 and February 2021, seven consecutive fulminant myocarditis patients (mean age: 41.1 ± 26.1years) received central ECMO support with transapical LV decompression, with an 18 French cannula integrated into the ECMO circuit in a Y-fashion. The baseline characteristics and postoperative outcomes of the patients were collected. On admission, all patients received prior peripheral ECMO, and 85.7% (6/7) of patients received prior intra-aortic balloon pumping. However, all patients had refractory cardiogenic shock that failed prior to decompression. Six patients recovered successfully after a mean ECMO support of 20.0 ± 11.5days and five patients had no recurrence of cardiac decompensation. The mean ICU and mean hospital stays were 36.7 ± 23.5days and 60.6 ± 24.9days, respectively. Hospital mortality was 28.6% (2/7). Two patients died due to sepsis and stroke during hospitalization. Central ECMO with an LV vent was effective for fulminant myocarditis refractory to percutaneous cardiopulmonary support therapy and other therapies.

Predictors of in-Hospital Prognosis after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Requiring Mechanical Support Devices

Objectives: The study was designed to identify predictor variables of the hospitalized patient’s primary percutaneous coronary intervention (PPCI) for MI needing mechanical support systems including some intra-aortic balloon-pumping and percutaneous cardiopulmonary. However, these predictors are still unknown. Place and Duration: The research was carried out at National Institute of Cardiovascular Disease with the duration from 5th September 2021 to 5th March 2022. Methodology: Clinical history, angiographic research results, primary PCI outcomes, as well as in hospital prognosis were retroactively evaluated by comparing primary PCI treated acute myocardial infarction patients needing mechanical aid devices (with intra-aortic balloon pump patient populations, n=550) versus those without (IABP patients, n=755). In comparison to individuals without IABP, those with intra-aortic balloon pump were much more inclined to have a greater proportion of diseased vessels, a lower TIMI score in the infarct related artery (IRA), and a considerably high death rate of hospitalized patients. On multivariate analysis, possession of Thrombolysis In Myocardial Infarction greater than or equal to 3 flow in the infarct-related artery right after PPCI was the poor indicator in the without intra-aortic balloon pump patients, in contrast to the patients with IABP. The percentage of diseased vessels or diseased left main trunk at preliminary cardiac catheterization was the impartial predictive factor of the hospitalized patient’s fatalities in the sufferers with IABP, but not in the sufferers without intra-aortic balloon pump. Results: A significant risk factor for fatality in hospitalized patients in PPCI-treated acute myocardial infarction patients needing mechanical assistance devices is the proportion of diseased vessels ≥ 2 or diseased left main trunk at baseline CAG. Keywords: Percutaneous cardiopulmonary support; Intra-aortic balloon pumping, PPCI or primary percutaneous coronary intervention; Multi-vessel disease

A Case of Anaplastic Thyroid Cancer in Which Tracheostomy Was Performed in Preparation for Percutaneous Cardiopulmonary Support (PCPS)

A Case of Anaplastic Thyroid Cancer in Which Tracheostomy Was Performed in Preparation for Percutaneous Cardiopulmonary Support (PCPS)

A Case of Acute Pulmonary Thromboembolism Leading to Cardiopulmonary Arrest Three Days after Total Gastrectomy with Survival Due to Percutaneous Cardiopulmonary Support and Surgical Thrombectomy

症例は72歳の男性で，胃癌に対して開腹胃全摘術を施行し，術後3日目に意識消失に続き心肺停止状態となった．心肺蘇生を開始し経皮的心肺補助装置（percutaneous cardiopulmonary support；以下，PCPSと略記）を導入した後に，心臓超音波検査での右室拡大，左室圧排像より急性肺血栓塞栓症を疑い，造影CTにて両側肺動脈の巨大塞栓像を認め，急性肺血栓塞栓症と診断した．胃癌術後3日目であることから，術後の出血リスクを考慮し血栓溶解療法ではなく外科的血栓除去術を施行した．血栓摘除直後より血行動態および酸素化の改善を認めた．術後の経過中に肺膿瘍を合併し入院が長期化したが，神経学的な後遺症は認めず，血栓除去術後52日目に自宅退院した．胃癌術後に心肺停止に至る急性肺血栓塞栓症を発症し，PCPSによる早期心肺蘇生および外科的血栓除去術により救命しえた症例を経験したため報告する．

Usefulness of excimer laser in acute coronary syndrome with left main coronary artery: a case series.

BackgroundAcute coronary syndrome caused by unprotected left main coronary artery (ACS-ULMCA) occlusion has a high mortality due to the formation of plaques and rich thrombi. Although excimer laser coronary angioplasty (ELCA) is effective in debulking and ablation of plaque burden and rich thrombi, its effectiveness in ACS-ULMCA remains unknown.Case summaryWe conducted percutaneous coronary intervention (PCI) using ELCA for six patients with ACS-ULMCA from February 2016 to May 2019. This case series includes a 65-year-old man who presented with sudden-onset chest pain. Angiography revealed subtotal occlusion of the left main coronary artery (LMCA). The use of a 0.9-mm ELCA catheter advanced from LMCA to the left anterior descending artery markedly improved coronary blood flow, and intravascular ultrasound revealed debulking of the plaque and thrombus. Another 79-year-old man presented with chest pain. Angiography revealed total occlusion of LMCA. Use of a 0.9-mm ELCA catheter improved coronary blood flow. Subsequent kissing balloon technique led to satisfactory results. All cases needed mechanical support (such as intra-aortic balloon pumping or percutaneous cardiopulmonary support) prior to PCI. Five patients survived finally, and one died 34 days after primary PCI.DiscussionAfter stabilizing haemodynamics by mechanical support, ELCA could be a good option to improve coronary blood flow in patients with ACS-ULMCA.

Efficacy and outcomes of balloon pulmonary angioplasty in elderly vs non-elderly chronic thromboembolic pulmonary hypertension patients

Abstract Introduction Balloon pulmonary angioplasty (BPA) has been reported as an effective and safe treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, its safety and efficacy in elderly patients remains unknown. Purpose We investigated the effect of BPA on hemodynamics and respiratory parameters, functional capacity, and short- and long-term outcome in elderly patients. Methods From November 2012 to May 2018, 141 consecutive CTEPH patients who underwent BPA in a single university hospital were enrolled (age: 65 [54.5–74] years old, WHO functional class [WHO-FC] II/III/IV; 35/96/10). Patients were divided into two groups according to the age; elderly (≥75 years, N=32) and young groups (&amp;lt;75 years, N=109). Hemodynamics (right-sided heart catheterization), biomarkers (brain natriuretic peptide), respiratory function (spirometry and diffusion capacity measurement), and functional capacity (6-minute walk distance [6MWD] and WHO-FC) were evaluated at baseline and 1-year post BPA. Procedure-related complications (in hospital death, use of percutaneous cardiopulmonary support [PCPS], and pulmonary injury) and all cause death during the follow up period were also assessed. Results At baseline, although elderly group had less severe hemodynamics (mPAP: 33.1±6.7 vs 39.0±11.8 mmHg, p&amp;lt;0.05), they had poor exercise capacity and reduced pulmonary diffusion capacity, compared with young group (6MWD: 264.6±101.3 vs 369.7±105.2 m, %DLco: 42.0±12.0 vs 50.2±12.7%, all p&amp;lt;0.05). BPA improved hemodynamics, biomarkers, exercise capacity, and pulmonary diffusion capacity in both elderly and young groups (all p&amp;lt;0.05). There was no in-hospital death or use of PCPS in both groups, although the incidence of pulmonary injury was higher in elderly group (14.3% vs 5.3%, p&amp;lt;0.01). Under the normalized hemodynamics 1-year after BPA in both groups, exercise capacity and pulmonary diffusion capacity were worse in the elderly group than young groups (p&amp;lt;0.01). The incidence of all-cause death in the follow up period was higher in elderly group, all of which were due to non-pulmonary hypertension (PH)-related death (p&amp;lt;0.01). Conclusion BPA was effective in improving hemodynamics and respiratory parameters and functional capacity, in associated with no critical complication, regardless of the age. Elderly patients who were treated with BPA were associated with higher incidence of non-PH-related death. Changes of mean PAP in the two groups Funding Acknowledgement Type of funding source: None

Percutaneous Cardiopulmonary Support：PCPS

Percutaneous Cardiopulmonary Support：PCPS

Application and Comparison of Different Prognostic Scoring Systems in Patients Who Underwent Cardiologist-Managed Percutaneous Cardiopulmonary Support.

Temporary mechanical support, including percutaneous cardiopulmonary support (PCPS), is crucial for reversing patients' compromised hemodynamic function. Knowledge about whether cardiologists can directly manage patients receiving PCPS and about the predictive values of different prognostic scores is insufficient. We examined the data and in-hospital mortality of 45 eligible patients receiving cardiologist-managed PCPS from July 2012 to January 2019 in our institute. We compared different prognostic scores [namely Survival After Veno-arterial ECMO (SAVE), modified SAVE, prEdictioN of Cardiogenic shock OUtcome foR acute myocardial infarction patients salvaGed by VA-ECMO (ENCOURAGE), and Sequential Organ Failure Assessment (SOFA) scores] through area under the receiver operating characteristic curve (AUC) analysis. The patients' mean age was 64.3 ± 11.3 years, and 71.1% were men. The overall in-hospital survival rate was 35.6%. Compared to survivors, nonsurvivors were more likely to have an ischemic etiology, cardiopulmonary resuscitation, and higher lactate levels. Survivors had higher SAVE (-5.9 vs. -11.4) and modified SAVE (4.2 vs. -7.1) scores than nonsurvivors (both p = 0.001), but SOFA (9.7 vs. 10.3) and ENCOURAGE (24.8 vs. 26.8) scores were similar (both p > 0.1). In multivariate models, only modified SAVE score remained statistically significant (hazard ratio: 0.96, 95% confidence interval: 0.93-1.00; p = 0.047). Modified SAVE score showed the best risk discrimination (AUC = 0.78). Establishing regular and continual training protocols can enable cardiologists to perform emergency PCPS (without on-site surgery) and daily care for patients with refractory cardiogenic shock. The modified SAVE score facilitates risk stratification and future decision-making processes.

Pitfalls of anesthetic management with the Impella\xae 5.0 device: a case series

BackgroundImpella® is an antegrade left ventricular assist device with a pump catheter in the left ventricle. We report three cases in which we experienced some pitfalls with circulatory management during Impella placement due to new-onset aortic insufficiency (AI) associated with device placement or the limited maximum flow rate.Case presentationThree patients developed new-onset AI due to Impella placement. In a patient, the total assisted flow rate was relatively low because of his large body size. In the other patients, in whom the Impella device was used in combination with percutaneous cardiopulmonary support or venoarterial extracorporeal membrane oxygenation (ECMELLA), total flow was maintained at a sufficient level.ConclusionsNew-onset of AI after Impella placement and its limited flow rate are considered to be pitfalls in circulatory management. Management with ECMELLA is considered to be effective during the acute phase when patients have decreased cardiac function.

Epidemiological Features and Clinical Presentations of Acute Coronary Syndrome in Young Patients.

Objective Although acute coronary syndrome (ACS) is an uncommon entity in young patients, it constitutes an important problem due to the devastating effects of the disease on the more active lifestyle of young patients. At present, there are no guidelines regarding the prevention of ACS in young patients. Methods We performed a retrospective study of ACS patients between 2014 and 2017. Epidemiological data, clinical findings, and short-term outcomes were evaluated between young ACS patients (≤50 years old) and elderly ACS patients (>50 years old). Results Of a total of 361 consecutive ACS patients, 37 were young ACS patients (10.2%). Compared with elderly ACS patients, young ACS patients showed a higher prevalence of males (94.6% vs. 73.8%, p<0.001), current smoking (70.3% vs. 29.9%; p<0.001), and overweight persons (67.6% vs. 27.8%, p<0.001). The eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio was significantly lower in young ACS patients than in elderly ACS patients [0.17 (0.12-0.25) vs. 0.25 (0.18-0.37), p=0.002]. The prevalence of cardio-pulmonary arrest and percutaneous cardiopulmonary support use was higher in young ACS patients than in elderly ACS patients (24.3% vs. 8.6%, p=0.003, 16.2% vs. 3.1%, p<0.001). Conclusion The features were markedly different between young ACS patients and elderly ACS patients. In young ACS patients, smoking, being overweight, and a low EPA/AA ratio were distinctive risk factors, and more serious clinical presentations were observed at the onset of ACS than in older patients.

489. Risk Factors for Mortality in Patients with Elizabethkingia and Clinical Impact of Antimicrobial Susceptibility Patterns

Background Elizabethkingia spp. is a non-fermenting, non-motile, oxidase-positive gram-negative aerobic bacilli that is ubiquitous in the environment, found in freshwater, saltwater and soil. Nowadays, they are emerging as nosocomial pathogens. In this study, we analyzed Elizabethkingia spp infected cases clinically and microbiologically.MethodsThis study was performed to evaluate the risk factors for mortality and to study the impact of microbiologic response on clinical outcomes in patient with Elizabethkingia spp Data on 210 patient of Elizabethkingia pneumonia and bacteremia that have occurred between November 1, 2005, and May 31, 2016, in a teaching hospital (2000 beds) in Seoul, Korea, were analyzed. Furthermore, antimicrobial susceptibility testing of Elizabethkingia from sputum and blood cultures was performed by E test for rifampin, moxifloxacin and vancomycin.ResultsAmong 210 patients, there were 157(74.8%) survivor and 53(25.2%) non-survivor. Among these patients, 129 patients (61.4%) were male and the median age was 66.5 years. There were no significant differences in the Charlson comorbidity index between survivor and non-survivor groups (P = 0.413). In the multivariate logistic regression, microbiologic failure (odds ratio [OR], 7.862; 95% confidence interval [CI], 3.448–17.931; pElizabethkingia infection (OR, 1.032; 95% CI, 1.013–1.051; P = 0.001), previous use of immunosuppressants (OR, 3.309; 95% CI, 1.334–8.210; P = 0.010), and Percutaneous cardiopulmonary support system use at the time of Elizabethkingia infection (OR, 7.439; 95% CI,1.180–46.900; P = 0.033) were significantly associated with 28day mortality. Patients with moxifloxacin-resistant and vancomycin-resistant showed higher mortality rate but no statistically significant difference.ConclusionThe early identification of these clinical factors in patients with Elizabethkingia infection is important to improve prognosisDisclosures All authors: No reported disclosures.

Potential benefit of non-cardiac arrested thromboembolectomy of acute pulmonary embolism for the impaired right ventricular function

ObjectivesAcute pulmonary thromboembolism is a fatal condition with high mortality rate in patients with hemodynamic collapse. Early diagnosis and aggressive treatment after circulatory collapse due to pulmonary thromboembolism are important. Although catheter-directed therapy or surgical thromboembolectomy could be considered, the prognosis of such cases is poor.MethodsWe reviewed nine consecutive patients who underwent surgical intervention for acute pulmonary thromboembolism requiring cardiopulmonary resuscitation from March 2010 to May 2017. The patients’ demographics, risk factors, operative and postoperative outcomes were retrospectively analyzed. All nine patients who experienced cardiopulmonary arrest or pulseless electrical activity had received cardiopulmonary resuscitation, including endotracheal intubation with cardiac massage. Computed tomography revealed massive pulmonary thromboembolism. Percutaneous cardiopulmonary support was initiated in six cases. Pulmonary thromboembolectomy was performed on a beating heart without aortic cross-clamping in all patientsResultsThe mean operation time was 251.9 ± 74.7 min. Among the six patients who received preoperative percutaneous cardiopulmonary support, three were able to wean off cardiopulmonary bypass during the surgery. The other three cases were able to wean off within 3 days postoperatively. The mean postoperative intubation time was 56.3 h. No mortality was observed. All patients were discharged with New York Heart Association functional class I without any neurological complications. No patients developed major and residual thrombi in the pulmonary artery upon postoperative computed tomography.ConclusionsPulmonary thromboembolectomy on a beating heart for acute pulmonary thromboembolism may be beneficial for minimizing right ventricular damage and improving clinical outcomes.

ACUTE HEART FAILURE SECONDARY TO FULMINANT MYOCARDITIS IN SETTING OF INFLUENZA A VIRUS: A CASE REPORT

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Acute myocarditis is a well documented sequelae of the influenza virus. The severity of infections can range from asymptomatic to fulminant heart failure and even sudden cardiac death, although such fulminant myocarditis associated with influenza is an exceptionally rare finding as per literature review. Here we present a case of a young girl with fulminant myocarditis and subsequent acute heart failure with reduced ejection fraction in the setting of Influenza A virus. CASE PRESENTATION: 19-year-old female with who presented with chest pain. Her hospital course included acute heart failure with echo showing focal hypokinesis of the basal-infero and baso-lateral wall with an ejection fraction of 25-30% in the setting of fulminant myocarditis due to Influenza A Virus; which was further complicated by septic shock due to multibacterial pneumonia that lead to acute hypoxic respiratory failure requiring intubation and vasopressors. Patient subsequently had immunologic work up done that revealed she was a cystic fibrosis carrier and had hypogammaglobulinemia which presumably increased her risk of developing severe upper respiratory tract infections and subsequently increased her risk of fulminant myocarditis and heart failure which as per our literature search is a rare finding in Influenza A (i.e., In one study its reported as an incidence of 0.4% [2/505 patients] and in another 0.7% [6/838 patients]). Patient began to show significant signs of improvement once she began to receive Intravenous Immunoglobulin therapy and she was successfully extubated and taken off of vasopressors and discharged shortly after. DISCUSSION: Given its rarity, it begs to question how this patient developed this. As per our literature search there was not much mention of the populations most at risk. It is a reasonable assumption that given the patients hypogammaglobulinemia she has been at increased risk of viral infections and in particular upper respiratory tract infections as evidenced by her previous Epstein Barr Virus episode as well as two prior walking pneumonia episodes. CONCLUSIONS: In summary, the frequency of fulminant myocarditis secondary to Influenza A virus is unclear, but what remains is that early recognition, supportive care and inotropic support are mainstays of treatment. It appears that those with apparent immunodeficiency are more susceptible to the fulminant presentation as evidenced by the rarity of documented cases. Our recommendation is that if patients experience fulminant myocarditis and subsequent acute heart failure in the setting of Influenza A Virus, it may be beneficial to obtain a immunologic work up to further evaluate those patients that may be at increased risk as the findings may affect treatment/prophylaxis to prevent or reduce future episodes as the patients are are increased risk for progressing to Common Variable Immunodeficiency (CVID). Reference #1: Caforio AL, Pankuweit S, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013 Sep;34(33):2636-48, 2648a-2648d. Epub 2013 Jul 3. Reference #2: Randolph AG, Vaughn F, et al. Critically ill children during the 2009-2010 influenza pandemic in the United States. Pediatrics. 2011;128(6):e1450. Epub 2011 Nov 7. Reference #3: Kato S, Morimoto S, Hiramitsu S, Nomura M, Ito T, Hishida H. Use of percutaneous cardiopulmonary support of patients with fulminant myocarditis and cardiogenic shock for improving prognosis. Am J Cardiol. 1999; 83:623–625. DISCLOSURES: No relevant relationships by Liziamma George, source=Web Response No relevant relationships by Janish Kothari, source=Web Response No relevant relationships by Sapan Patel, source=Web Response